Releuko — CareFirst (Caremark)
CAR T-cell-related toxicities (supportive care for neutropenic patients)
Preferred products
- Neupogen
- filgrastim biosimilars
- Nivestym
- Granix
- Zarxio
- Nypozi
Initial criteria
- Member must have one of the listed indications
- For chemotherapy-induced febrile neutropenia prophylaxis, regimen has intermediate or high risk (≥10% incidence) for febrile neutropenia or patient has specific risk factors such as active infection, open wounds, recent surgery, age ≥ 65 years, bone marrow involvement, previous chemotherapy/radiation, poor nutritional or performance status, renal/liver dysfunction, HIV infection, cardiovascular disease, or previous febrile neutropenia episodes
- For other indications, condition-specific diagnosis as listed must be documented
Reauthorization criteria
- All members requesting continuation of therapy must meet all initial authorization criteria
Approval duration
6 months